Remote Clinical Resolution Specialist (CPhT)

Empirx-Health-4; United States; On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Paid Time Off

Health Insurance including Dental &amp

Vision coverage

Job summary

EmpiRx Health is seeking a Care & Resolution Specialist (CPhT) for a fully remote role in the United States. You will be the primary point of contact for complex member inquiries, resolving escalated concerns with clinical awareness and empathy, collaborating with pharmacies, prescribers, and internal teams.

The position emphasizes comprehensive knowledge of PBM workflows, claims adjudication, and cost-containment programs, while maintaining compliant communication with members.

Qualifications

• Minimum 2 years in PBM/health plan/MTM call center or 4 years in hospital/retail pharmacy.
• At least 2 years in a customer service-related field, preferably healthcare.
• Prior experience with benefit investigations, prior authorizations, or claims processing preferred.

Responsibilities

• Respond to inbound member calls and inquiries with empathy and precision.
• Monitor adherence to processes, protocols, and escalation paths.
• Serve as liaison between members, internal departments, and external partners.
• Manage cases related to prescription claims, authorizations, and PBM concerns.

Skills

Customer service

Communication

CRM experience

Critical thinking

Tools

CRM systems

Job description

EmpiRx Health is seeking a Care & Resolution Specialist (CPhT) for a fully remote role in the United States. You will be the primary point of contact for complex member inquiries, resolving escalated concerns with clinical awareness and empathy, collaborating with pharmacies, prescribers, and internal teams.

The position emphasizes comprehensive knowledge of PBM workflows, claims adjudication, and cost-containment programs, while maintaining compliant communication with members.